Lee Wei-Chieh, Fang Chih-Yuan, Chen Yung-Lung, Fang Hsiu-Yu, Chen Huang-Chung, Liu Wen-Hao, Fu Morgan, Chen Mien-Cheng
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City, Taiwan, Republic of China.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City, Taiwan, Republic of China.
J Stroke Cerebrovasc Dis. 2019 Jan;28(1):90-96. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.015. Epub 2018 Oct 6.
There are few reports about non-vitamin K antagonist oral anticoagulant (NOAC) treatment for resolution of left atrium (LA) or left atrial appendage (LAA) thrombus. LAA thrombus is an important cause of cardiogenic cerebral thromboembolism, and the detection rate increases due to more and more patients receiving catheter ablation. However, the results from NOAC use for LA or LAA thrombus are still unknown in real-world practice. The aim of this study was to discover the resolution of LA or LAA thrombus after anticoagulant treatment in real-world practice.
From January 2013 to December 2016, a total 864 patients underwent transesophageal echocardiography (TEE), and 41 cases of LA or LAA thrombus were detected in our hospital. Among them, a total of 22 patients underwent follow-up TEE to detect the resolution of LA or LAA thrombus.
The average age of the study patients was 72.0 ± 11 years old, and 61% were male. The average CHA2DS2-VASc scores were 3.76 ± 2.01 points. A total of 22 patients underwent follow-up TEE, and 19 (86.4%) patients presented LA or LAA thrombus resolution. The average resolution duration was 258.47 ± 218.17 days. One-year all-cause mortality was 4.9%, and the incidence of ischemic stroke was 4.9%. Most physicians favored titration of the dosage of NOAC or warfarin in real-world practice.
In real-world practice, most physicians favored titration of the dosage of NOAC or warfarin for LA or LAA thrombus. LA or LAA thrombus could exist if the patient received a reduced dose of NOAC. High frequency of LAA or LA thrombi could resolve, and a low incidence of ischemic stroke occurred after adjustment of oral anticoagulant treatment.
关于非维生素K拮抗剂口服抗凝药（NOAC）治疗左心房（LA）或左心耳（LAA）血栓溶解的报道较少。LAA血栓是心源性脑栓塞的重要原因，随着越来越多的患者接受导管消融，其检出率有所增加。然而，在实际临床实践中，使用NOAC治疗LA或LAA血栓的效果仍不明确。本研究的目的是探讨在实际临床实践中抗凝治疗后LA或LAA血栓的溶解情况。
2013年1月至2016年12月，共有864例患者接受了经食管超声心动图（TEE）检查，我院共检测出41例LA或LAA血栓。其中，共有22例患者接受了随访TEE检查以检测LA或LAA血栓的溶解情况。
研究患者的平均年龄为72.0±11岁，男性占61%。平均CHA2DS2-VASc评分为3.76±2.01分。共有22例患者接受了随访TEE检查，其中19例（86.4%）患者的LA或LAA血栓溶解。平均溶解时间为258.47±218.17天。1年全因死亡率为4.9%，缺血性卒中发生率为4.9%。在实际临床实践中，大多数医生倾向于调整NOAC或华法林的剂量。
在实际临床实践中，大多数医生倾向于调整NOAC或华法林的剂量来治疗LA或LAA血栓。如果患者接受较低剂量的NOAC，LA或LAA血栓仍可能存在。LAA或LA血栓的溶解频率较高，调整口服抗凝治疗后缺血性卒中的发生率较低。
